[Alexithymia and Pathological Gambling: The Mediating Role of Difficulties in Emotion Regulation]

OBJECTIVE

The main objective was to determine the prediction level of alexithymia and difficulties in emotion regulation on pathological gambling. Secondly, this study aimed to examine the mediating role of difficulties in emotion regulation on the relationship between alexithymia and pathological gambling.

METHOD

The sample was consisted of 246 male gamblers. The average age was 33.30 with a standard deviation of 11.62. In addition to socio-demographic form, The South Oaks Gambling Screen (SOGS), Toronto Alexithymia Scale (TAS-20) and Difficulties in Emotion Regulation Scale (DERS) were used to collect data.

RESULTS

Regression analyses revealed that amount of money bet, total score of TAS-20 and DERS significantly predicted pathological gambling. In addition to these, difficulties in emotion regulation have a partial mediator role in the relationship between alexithymia and pathological gambling.

CONCLUSION

It is argued that individuals high in alexithymia become prone to addiction behavior through emotion dysregulation. In addition to the alexithymia level, difficulties in emotion regulation are seen to play an important role in pathological gambling. In this context, this study contributes to the relevant literature by discussing alexithymia, emotion regulation and pathological gambling together.

A survey of verbal and physical assaults towards psychiatrists in Turkey

BACKGROUND

Assaults on health professionals have been an area of burgeoning clinical and political interest in recent years. There is now a body of literature suggesting that violence towards psychiatrists is more common than to other doctors. Thus far the vast majority of research in this area has been conducted in Western European and North American clinical settings. For the first time, this study examines this issue in the context of Turkish psychiatric settings.

OBJECTIVE

(i) The study aims to detect the prevalence of verbal and physical assaults towards psychiatrists in Turkey. (ii) It aims to compare the experience of verbal and physical assaults according to the gender and training experience of psychiatrists. (iii) The paper intends to investigate how psychiatrists reacted to and appraised the experience of violence.

METHODS

A questionnaire was prepared to evaluate violence towards psychiatrists (adapted from the Overt Agression Scale). The questionaire was administered to psychiatric specialists and residents working in state hospitals, research and training hospitals, mental health hospitals and university psychiatry clinics. A response rate of 93% was achieved with 186 out of 200 psychiatrsits approached completing the study questionnaire.

RESULTS

Of all the psychiatrists who responded, 71% reported having experienced verbal or physical assaults during their professional life (verbal assaults only (19.9%), physical assaults only (2.7%) and both (48.4%)). Of these, 26% suffered injury to at least a mild degree. There was no statistically significant difference in terms of gender and workplace. In spite of the extremely high rates of aggression and violence towards psychiatrists, roughly 50% perceived these acts a normal part of their job and only 5% formally reported the violent incident.

CONCLUSION

The majority of psychiatrists described having been victims of verbal and physical assaults although half perceived aggression and violence as a normal part of their job. Levels of reporting of violence were very low in the context of this study. Studies such as this provide evidence to inform the development of improved management of violence and may encourage psychiatrists to report violence.

Adherence to Turkish psychiatric association guideline for bipolar depression treatment in a specialized mood disorders outpatient unit

BACKGROUND

Bipolar patients spend up to one third of their lives in depression however, acute treatment guidelines mainly focused on the manic phase of illness. With recent attention to the importance of evidence-based medicine in psychiatry, a number of treatment guidelines have emerged to aid clinicians in clinical decision making. Here, we aim to measure concordance with the Turkish Psychiatric Association Treatment Guideline for Bipolar Disorders (TPATGBD) for the depressive phase of illness.

SUBJECTS AND METHODS

Bipolar patients attending the Rasit Tahsin Mood Disorders Outpatient Unit of Istanbul Bakırköy Research and Training Hospital for Psychiatry, Neurolgy & Neurosurgery, were assessed using standardized forms based on a nation-wide mood disorders follow-up program. Concordance of implementations with the TPATGBD were evaluated step by step for each level of depression severity.

RESULTS

Concordance rates with the first step recommendations of the guideline were 29.4%, 27.4% and 87.5% for mild-moderate, moderate-severe (without psychosis) and severe depression (with psychosis), respectively. Concordance rates with the second step recommendations of the guideline were lower for bipolar depressions without psychosis. Overall, adherence to the guideline did not impact on time to remission (p=0.19).

CONCLUSIONS

Despite considerable efforts to develop and disseminate evidence-based guidelines, they are not widely followed by clinicians and important opportunities clearly exist to educate clinicians about the feasibility and utility of clinical guidelines for bipolar disorder. Systematic studies in the future are required to clarify our understanding of clinicians' attitudes to the use of guidelines and to explain the discrepancy between guidelines and clinical practice.

[Attitudes and behaviors of psychiatry residents and psychiatrists working in training institutes towards the relationship between the pharmaceutical industry and physicians]

OBJECTIVE

To determine the attitudes and behaviors of psychiatrists and psychiatry residents towards pharmaceutical representatives and their promotional activities, and to evaluate the effect of the duration of residency and type of the training institution on these attitudes and behaviors.

METHOD

A validated questionnaire for assessing the attitudes and behaviors of physicians towards the pharmaceutical industry was administered to psychiatrists and psychiatry residents at regional meetings. Of the 1973 participants, 348 responded.

RESULTS

Although there was significant interaction between psychiatrists and pharmaceutical representatives, 50.7% of psychiatrists reported that they thought these interactions had no impact on their prescribing practices. First- and second-year residents agreed more than the other residents and the specialist that pharmaceutical representatives provided accurate information and had no effect on physician prescribing practices. First- and second-years residents agreed less than older residents that pharmaceutical representatives used marketing techniques. The psychiatrists regarded most of the pharmaceutical promotions as appropriate. State hospital staff agreed more than the university hospital staff that the pharmaceutical industry should support educational meetings in their institutions.

CONCLUSION

There was intense interaction (3/4)characterized by undefined boundaries (3/4)between psychiatrists and the pharmaceutical industry. Most physicians were not provided any guidelines concerning their interactions with pharmaceutical representatives and there was general concern about the necessity of restricting these interactions.

[Genetic studies of bipolar disorder: a review]

Bipolar disorder is a severe mental illness that afflicts approximately 1% of the world's population, and is characterized by mood swings from elation to depression. Although the etiology of bipolar disorder remains unclear, heritable factors have been shown to be involved. Family, twin, and adoption studies suggest a genetic etiology. Molecular genetic studies also support a genetic component. Many chromosomal regions have been implicated by these molecular genetic studies, but no single susceptibility gene has been identified. These findings show that bipolar disorder has a complex genetic etiology in which multiple unidentified genes and environmental factors play an important role in its pathogenesis. Herein, molecular genetic studies of bipolar disorder are reviewed based on a search of Medline using the key words, bipolar, genetic, and chromosome. Studies with positive results for bipolar disorder were selected first. The findings from these molecular genetic studies are reviewed systematically, chromosome by chromosome. Causes of the differences between the reported findings and of non-replication are discussed. Finally, important factors for designing a genetic study of bipolar disorder are examined.

Stigmatization in the long-term treatment of psychotic disorders

Stigma is linked to negative prejudices without examining whether there is any justification for such behaviour. Over time, various efforts have been made to reduce prejudice toward people with mental illness. Yet, the World Health Organization (WHO) World Health Report still describes stigma as one of the greatest obstacles to the treatment of mental illness. While schizophrenia, among other mental illnesses, is the most stigmatized even to the point that some want the name of the illness to be hidden or changed, patients with bipolar illness may also be exposed to stigma. The degree of stigmatization has been found to be positively associated with the severity of the mental disorder, and stigma is carried out not only by patients but also by their families in correlation with the severity. Tragically, people with mental illness themselves are as negative in their opinions about mental illness as is the general public, and concerns about stigma adversely affect self-esteem and adaptive social functioning. There are many programmes worldwide for the fight against stigmatization, and there is clear recognition of the fact that stigma can only be successfully eliminated if the programme becomes a normal part of health service rather than of campaigns of limited duration.

[Development of a questionnaire to assess inter-episode functioning in bipolar disorder: Bipolar Disorder Functioning Questionnaire]

OBJECTIVE

Even though quality of life and functioning are topics that are point of interest, they are not assessed adequately in mood disorders. In this study, it is aimed to develop a functioning assessment scale in bipolar disorder.

METHOD

Bipolar Disorder Functioning Questionnaire (BDFQ) is developed by the Scientific Section for Mood Disorders of the Psychiatric Association of Turkey. The questionnaire contains 58 items, and consists of eleven subscales: emotional functioning, intellectual functioning, sexual functioning, feelings of stigmatization, social withdrawal, household relations, relations with friends, participation to social activities, daily activities and hobbies, taking initiative and self sufficiency, and occupation.

RESULTS

In this study, 252 remitted bipolar patients from 15 centers were included. In addition, thirty subjects without any lifetime psychiatric, neurological or physical disease were recruited. The mean age of the patients was 38.6+/-12.1 and 56% (n=141) were female. The mean duration of the bipolar disorder was 11.9+/-9.2 years, and 91.3% of the patients were diagnosed to have bipolar I disorder. In the reliability analyses, after the exclusion of six items with low reliability coefficients, The Cronbach alpha coefficient was calculated to be 0.91. The item-total scale correlations were between 0.22-0.86. In test-retest reliability, the correlation between the two ratings was high (r=0.82, p<0.0001). In validity analyses, 13 factors were obtained representing 65.1% of the total variance in exploratory factor analysis. In confirmatory factor analysis, 11 domains fit the model with a RMSEA of 0.061. BDFQ significantly correlated with GAF (r=0.428, p<.0001). BDFQ also showed significantly negative correlation with HAM-D (r=-0.541, p<0.0001) and YMRS (r=-0.365, p<0.0001). It discriminated the patients (mean score=111.8+/-15.2) from the healthy subjects (mean score=121.4+/-10.4) well (t=-2.300, p=0.038).

CONCLUSION

With the six items excluded, it is suggested that the 52-item BDFQ is a reliable and valid instrument in the assessment of functioning in bipolar disorder.

[Reliability and validity of the schedule for deficit syndrome in schizophrenia]

OBJECTIVE

The Schedule for Deficit Syndrome (SDS) is an instrument for categorizing schizophrenic patients as those with and without deficit syndrome. This schedule has been translated and adapted into the Turkish language in order to study its reliability and validity.

METHOD

30 male schizophrenic patients were included in the study. The patients had been ill for a long period of time and the course was continuous. The patients were assessed by two different raters using the SDS as a means of testing its reliability. A third rater assessed the same group of patients using the BPRS to test the validity of the SDS.

RESULTS

The raters using the SDS demonstrated good inter-rater reliability for the categorization of patients with and without deficit syndrome, as well as for rating global severity (kappa: 0.88-0.93) and individual negative symptoms (kappa: 0.51-0.61). The schedule was also found to have a high validity for both categorization and measuring individual negative symptoms. (U: 60.0, P: 0.03).

CONCLUSION

The results demonstrated that the Turkish version of the SDS would be a reliable and valid instrument that could be used in the study of schizophrenia.

Bipolar depression: an overview

Depressive episodes are significant in bipolar illness since patients can spend up to one-third of their lives in depression. Although the treatment of bipolar depression remains an understudied area, new data from randomized, controlled trials and naturalistic studies have expanded the range of treatments available. The main aim in the treatment of bipolar depression is the prevention of the patient switching to mania and cycle acceleration, and antidepressant therapy may be contraindicated because of the risk for switching. Guidelines for the acute treatment of bipolar depression emphasize treatment with a mood stabilizer, of which lithium has been the most thoroughly studied in randomized, controlled trials in acute bipolar depression. Lamotrigine has also demonstrated significant efficacy in recent studies and has been approved by the FDA.